Effectiveness of nirmatrelvir-ritonavir versus azvudine for adult inpatients with severe or critical COVID-19

IF 3.6 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2024-04-01 DOI:10.1136/bmjresp-2023-001944

Huan Zhang, Tan Xiaojiao, Junjun Chen, Zheng Zhang, Chenxi Wang, Haiqing Shi, Yao Li, Jianbo Li, Yan Kang, Xiaodong Jin, Xuelian Liao

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Abstract

Background In China, both nirmatrelvir-ritonavir (Paxlovid) and azvudine have been granted approval to treat adult SARS-CoV-2-infected patients with moderate symptoms. Information about the clinical effect of the two available agents among inpatients with severe or critical COVID-19 is scarce. Purpose To compare the clinical outcomes of Paxlovid and azvudine among adult inpatients with severe or critical COVID-19. Method We conducted a retrospective cohort study in two large medical centres after the epidemic control measures were lifted in China. A new propensity score matched-inverse probability of treatment weighting cohort was constructed to evaluate the in-hospital all-cause mortality, hospital length of stay, Sequential Organ Failure Assessment (SOFA) score and safety. Results A total of 955 individuals were in the cohort. The antiviral therapy strategies were decided by the senior physician and the supplies of the pharmacy. A total of 451 patients were in the Paxlovid group, and 504 patients were in the azvudine group. Compared with Paxlovid, the effects of azvudine on in-hospital all-cause mortality were not significantly different, and the OR (95% CI) was 1.084 (0.822 to 1.430), and the average hospital length of stay of patients discharged alive was also similar in the azvudine group, and the difference (day) and (95% CI) was 0.530 (−0.334 to 1.393). After 7 days of therapy, the degree of decline in the SOFA score was greater in the Paxlovid group than in the azvudine group (p<0.001). The change in glomerular filtration rate was not significantly different (p=0.824). Conclusion Paxlovid and azvudine had similar effectiveness on in-hospital all-cause mortality and hospital length of stay. Compared with the azvudine group, after 7 days of therapy, the degree of decline in SOFA score was significantly higher in the Paxlovid group. These findings need to be verified in larger prospective studies or randomised controlled trials. Data are available upon reasonable request.

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尼马瑞韦-利托那韦与阿兹夫定对重症或危重 COVID-19 成年住院患者的疗效比较

背景在中国，尼马瑞韦-利托那韦（Paxlovid）和阿孜夫定都已获准用于治疗中度症状的成年 SARS-CoV-2 感染者。有关这两种现有药物在重度或危重 COVID-19 住院患者中的临床效果的信息很少。目的比较 Paxlovid 和阿兹夫定对重症或危重 COVID-19 成年住院患者的临床疗效。方法在中国取消疫情控制措施后，我们在两个大型医疗中心开展了一项回顾性队列研究。我们构建了一个新的倾向得分匹配-反概率治疗加权队列，以评估院内全因死亡率、住院时间、序贯器官功能衰竭评估（SOFA）评分和安全性。结果该队列中共有 955 人。抗病毒治疗策略由资深医生和药房供应决定。Paxlovid组共有451名患者，阿兹夫定组共有504名患者。与帕克洛韦德相比，阿兹夫定对院内全因死亡率的影响无显著差异，OR（95% CI）为1.084（0.822~1.430），阿兹夫定组患者生还出院的平均住院时间也相似，差异（天）和（95% CI）为0.530（-0.334~1.393）。治疗7天后，帕洛维组的SOFA评分下降程度大于阿兹夫定组（P<0.001）。肾小球滤过率的变化无明显差异（P=0.824）。结论 Paxlovid 和阿兹夫定对院内全因死亡率和住院时间的疗效相似。与阿兹夫定组相比，治疗7天后，帕克洛韦组的SOFA评分下降程度明显更高。这些发现需要在更大规模的前瞻性研究或随机对照试验中加以验证。如有合理要求，可提供相关数据。

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.